Factors that influence healing of chronic venous leg ulcers: a retrospective cohort

Abstract

BACKGROUND Venous ulcers have a significant impact on patient quality of life, and constitute a worldwide public health problem. Treatment is complex, with high failure rates. OBJECTIVES To identify clinical and therapeutic factors that influence healing of venous ulcers. METHODS Retrospective cohort study of patients with venous ulcers. Ulcer area was measured at the first visit (T0) and after 6 months (T6) and 1 year (T12). A reduction in ulcer area of 50% or more at T6 and T12 was the outcome of interest, weighted by clinical, demographic and treatment aspects. RESULTS Ninety-four patients were included (137 ulcers). A reduction in ulcer area of 50% or more was seen in 40.1% of patients (95%CI 31.9 to 48.4%) at T6 and 49.6% (95%CI 41.2 to 58.1%) at T12. Complete healing occurred in 16.8% (95%CI 10.5 to 23.1%) at T6 and 27% (95%CI 19.5 to 39.5%) at T12. The lowest ulcer area reductions at T6 were associated with longstanding ulcer (RR=0.95; 95%CI 0.91 to 0.98), poor adherence to compression therapy (RR=4.04; 95%CI 1.31 to 12.41), and infection episodes (RR= 0.42; 95%CI 0.23 to 0.76). At T12, lower reductions were associated with longstanding ulcer (RR=0.95; 95%CI 0.92 to 0.98), longer topical antibiotic use (RR=0.93; 95%CI 0.87 to 0.99), and systemic antibiotic use (RR=0.63; 95%CI 0.40 to 0.99).CONCLUSIONSLongstanding ulcer, infection, poor adherence to compression therapy, and longer topical and systemic antibiotic use were independently correlated with worse healing rates.

Impacto de úlceras venosas na qualidade de vida de indivíduos atendidos na atenção primária

“…Estima-se que, aproximadamente, um por cento da população de países industrializados poderá ter essa lesão em algum momento da vida. Dessa forma, a UV é considerada um problema de saúde pública (1)(2)(3)(4)(5)(6), em especial, devido ao aumento de sua incidência, à cronicidade, aos altos custos terapêuticos e de acompanhamento clínico, à complexidade do cuidado e ao alto índice de recidiva (1-3).…”

Can Venous Ulcer Size be Associated with the Healing Potential of Serum? Pilot Study

“…Therefore, healing no longer depends on this factor. In this sense, another recent retrospective study [35] with ulcers up to nearly 300cm 2 also did not find the ulcer size was a risk factor for non-healing. This is consistent with Milic's [37] 52 weeks prospective study that showed that there is no association between the ulceration surface and the failure of venous leg ulcers to heal.…”

Aspects that Influence in the Quality of Life of People with Venous Ulcer

“…In this dynamic, studies claim that the presence of venous ulcers (VU) negatively impacts the QOL of people affected [5,6,7,8] and it is a major public health problem [3,9] because, having such injury, every aspect of life are affected, bringing general limitations [6].…”

“…Healthcare of a person with VU is complex [3,8] and requires planning and involvement of the multidisciplinary team that knows the profile and demands of this population [11], to intervene in QOL [5,6]. However, it is up to the professional nurse recognize the importance of this construct in the research and systematization of individualized and holistic care within the multidisciplinary team [3,12].…”